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General NPI Number Information
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NPI Number | 1508551904
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Entity Type | Individual
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Provider Name | MUATH A DARALSHEIKH
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Gender | Male
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 322 INDIANAPOLIS BLVD STE 106
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City | SCHERERVILLE
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State | IN
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Zip | 46375-4204
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Country | US
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Telephone | 219-244-6643
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Fax |
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Provider Business Mailing Address
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Address Line | 322 INDIANAPOLIS BLVD STE 106
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City | SCHERERVILLE
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State | IN
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Zip | 46375-4204
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Country | US
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Telephone | 219-244-6643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019034263
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License Number State | IL
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